My Dying Grandmother’s Pain Inspired Me to Challenge Zimbabwe’s Pharmaceutical System | Dudzai Mureyi

In July 2015, when my 82-year-old grandmother, Sophie Mafuku, was dying of a terminal illness in Zimbabwe, I spent a day talking to fellow pharmacists as I tried to fill her prescription for morphine. If it takes 24 hours for the grandmother of a well-connected medical professional to access rare drugs, I thought, how long does it take for unconnected people? It made me travel.

In Zimbabwe, systemic shortages are common. Sometimes only a handful of pharmacies have medicines in stock. The shortages are caused by well-documented economic challenges, which affect Zimbabwe’s ability to manufacture or import medicines.

Additionally, prices vary from one private sector pharmacy to another as drug prices in Zimbabwe are not regulated. Price comparison is essential for people who have to spend hard-earned US dollars on medications (some companies refuse payments in local currency and some health insurance plans).

The impact of shortages and fluctuating costs is exacerbated in Zimbabwe by advertising laws that prohibit the marketing of drugs. This is not unusual – many governments have such restrictions as a public safety measure. In Zimbabwe, however, this well-intentioned regulation means that pharmacies cannot advertise that they have a medicine that is not available or more expensive elsewhere. As a result, people often have to drag from pharmacy to pharmacy to inquire about availability and price in a costly and tedious process when a loved one is sick. It also violates a person’s right to access medication.

A pharmacy in Harare. Finding rare drugs may involve walking from one to another in search of the product. Photography: Tafadzwa Ufumeli/Getty

Motivated by my own family’s experience, I investigated whether there was a way to collect real-time stock and price information from hundreds of pharmacies in Zimbabwe.

I created the Medical Information Service (MIS) – a platform that would allow Zimbabweans to send the name or picture of any medicine they want to a WhatsApp number. MIS would then collect information from staff at licensed pharmacies in each region of the country and, within minutes, relay information about where the drugs were in stock and at what price.

In 2015, this proposal faced resistance from state health care regulators, who saw it as a covert way to illegally advertise. It took the Supreme Court to rule in November 2018 that SIM was legal. Three years later, in 2021, the Zimbabwean government, through a fund for digital innovators, awarded me a grant of Z$4 million (about £16,000 at the time of the award announcement) , to help implement the service.

The irony did not escape me that the government, through state regulators, had moved from fighting MIS to funding it.

Today, six and a half years after this frantic search for my grandmother’s morphine, the service is operational. It took a long time to practice a simple workaround to a critical issue. However, that time was well spent, talking to pharmacists and learning about crowdsourcing.

The department’s preliminary findings highlighted the need for greater price transparency in Zimbabwe’s pharmaceutical system as a first step towards reducing the cost of illness.

For example, the price of remdesivir, a drug used to manage Covid-19, ranges from $100 to $135 in pharmacies in the capital, Harare, while the cost of praziquantel, a deworming drug used to treat schistosomiasis, can cost between $3 and $18.

Zimbabweans using MIS have been able to achieve significant cost savings.

My grandmother passed away peacefully in July. She is survived by her children, her grandchildren — and by a frugal crowdsourcing intervention her morphine prescription inspired.

Dudzai Mureyi is a global health researcher and pharmacist based in Zimbabwe

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